Teen Drug Abuse in the Formative Years of Ernest Mrazik, Jr. RPh, MBA Generation RX Champion 2012

Real Danger “Abusing prescription (RX) and over-the-counter (OTC) drugs can be just as dangerous, addictive and even deadly as using ‘street’ drugs” National Institute on Drug Abuse, 2008

Troubling Indicators of Medicine Abuse Unintentional drug poisoning now the leading cause of accidental death in US, overtaking car crashes Emergency room visits related to Rx/OTC abuse now almost equal to ER visits due to all “street drugs” Rx drugs are now the most commonly abused drugs among year olds Centers for Disease Control and Prevention, The Three Leading Causes of Injury Mortality in the United States, , 2008; Drug Abuse Warning Network; Substance Abuse and Mental Health Services Administration, National Study on Drug Use and Health, 2007

Columbia University National Center on Addiction and Substance Abuse 12 to 17 years olds abuse prescription drugs more than they abuse ecstasy, crack/cocaine, heroin, and methamphetamine combined. 60% of teens who abused Rx pain killers did so before 15. There are as many new abusers (initiates or first-time users) age of prescription drugs as there are of marijuana. 90% of all adults with substance abuse disorder started using under age of 18 and half under age of 15. Children who first smoke marijuana under age of 14 are 5 times more likely to abuse drugs as an adult than those use marijuana at age 18.

shrooms, Ecstasy cocaine heroin, meth, crack cigarettes, beer/wine Prescription/over-the-counter drugs (Rx/OTC) Rx abusers are more likely to add a 3 rd rung in the progression liquor, marijuana Rx New Step in Drug Ladder

Rx Medications are All Around Us…and Teens Notice The Teen – Rx Abuse Connection  Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits.  Direct-to-consumer advertising on TV and in magazines is pervasive.  Many people don’t know how to safely use these medications or ignore their doctor’s instructions. R X A BUSE P REVENTION T OOLKIT - from awareness to action

Rx drugs are part of teen culture. Teens: As a result…  Normalize this form of drug abuse.  Take these meds for legitimate reasons – with or without a prescription – to stay awake, remain alert or to go to sleep.  Purposely abuse these drugs to get high. They participate in “pharming” and “bowling” parties.  Are often unaware that these activities can lead to disastrous results. R X A BUSE P REVENTION T OOLKIT - from awareness to action

that abusing Rx drugs can: Teenagers don’t know  Increase blood pressure or heart rate.  Damage the brain and other organs.  Lead to accidental overdose / poisonings.  Cause physical dependency and / or addiction.  Disrupt breathing (respiratory depression).  Lead to risks associated with mixing multiple drugs or combining with alcohol.  Cause seizures and even death. R X A BUSE P REVENTION T OOLKIT - from awareness to action

Parent/Child Conversation Most teens (62 percent) report that their parents have talked to them about drugs and alcohol in the past year. But only 17 percent of teens say their parents have talked to them about prescription drug abuse. The Partnership at Drugfree.org, Partnership Attitude Tracking Study, 2011

Postings on Social Networks Detailed instructions and conversations about DXM abuse; Blogs and videos with postings of how and when kids will take DXM- containing cough medicines; Footage of kids while “high.”

Opiate Withdrawal Dilated pupils, rhinorrhea (runny nose) Tachycardia, hypertension Nausea, Vomiting, diarrhea, abdominal cramps Goose bumps, sweats, muscle/bone/joint aches Insomnia, anxiety, headache

Sedative-Hypnotic Withdrawal Tremors, diaphoresis (sweats), nausea Anxiety, hyperreflexia, seizures Insomnia Hallucinations (seeing or feelings things, not hearing voices) Delirium tremens

Opana and Oxycontin users switching to Heroin Oxycontin new safe tablet arrived on the market August 2010 and Opana formulation change soon followed. Researchers found the percentage of Oxycontin users fell from 35.6% before the new formulation was introduced to 12.8% almost 2 years later. Primary abuse of other powerful opioids such as fentanyl, hydromorphone, oxymorphone, and heroin (doubled). Almost a quarter of drug users (24%) said they found a way around the tamper-resistant mechanism in Oxycontin (microwave), but the vast majority (66%) said they switched to another opioid instead.

Marijuana Potency

Onset: Three to five minutes Length of duration: One to eight hours Short-term effects: In addition to physical signs of use, users may experience: – Dysphoria – the opposite of euphoria – Paranoia – similar to PCP/Angel Dust – Delusions, hallucinations and increased agitation Long-term effects: Unknown Effects of Synthetic Marijuana Source: Prosecuting Attorneys Association of Michigan

CONNECTICUT PACT360 CT one of top 10 states for dependence on illicit drugs among young adults ages Heroin is the most commonly cited drug by the CT DEA. Once the supply of prescription opioids is cut off or the abuser’s tolerance requires very high doses, abusers move on to Heroin, since it is much cheaper. Example: Oxycontin 80mg tablet cost $80 but a day’s worth of Heroin is only $20. Heroin is readily available in the suburbs.

SAFEGUARD Keep track of your meds Parents (and other family members) are in the best position to reduce access to prescription drugs by locking up medicines and properly disposing of expired or unused medicines.  Monitor all medications in the home—prescription and OTC medicines.  Safely store medicines out of children’s reach and sight. Consider locking them up.  Get rid of old or unused medicines. R X A BUSE P REVENTION T OOLKIT - from awareness to action

Guidelines for Rx drug disposal FEDERAL GUIDELINES  Refer to October 15, 2009 FDA Guidelines for Disposal by Flushing.  Do not flush down toilet or drain unless label or accompanying patient information specifically instructs you to do so.  Dispose of Rx drugs not labeled to be flushed through community drug take-back programs. If a program is not available, dispose of medications appropriately: 1. Take medication out of its original packaging and place it into a disposable container with a lid or into a sealable bag. 2. Mix drugs with an undesirable substance (e.g., cat litter or used coffee grounds). 3. Place sealed container with the mixture and original packaging (be sure to remove all personal information from the packaging) in the trash. SAFEGUARD Office of National Drug Control Policy. Proper Disposal of Prescription Drugs Available at: R X A BUSE P REVENTION T OOLKIT - from awareness to action